Division of Clinical Immunology and Rheumatology, Department of Medicine, The University of Alabama at Birmingham.
J Clin Rheumatol. 2000 Jun;6(3):117-22. doi: 10.1097/00124743-200006000-00001.
Osteoporosis is a serious side effect of long-term glucocorticoid (GC) use, but there is little success at prevention. We sought to identify academic physicians' awareness of glucocorticoid-induced osteoporosis (GIOP) risk and the patient and provider characteristics that determine GIOP management. A retrospective chart review of 365 patients seen at The University of Alabama at Birmingham by 4 rheumatologists, 3 pulmonologists, and 3 gastroenterologists was performed. Of these, 59.2% were women and 69.3% were Caucasians. Only 110 patients (30.1%) received any type of GIOP prevention intervention. The patients receiving GIOP prevention were older (58.7 +/- 13.8 vs. 49.8 +/- 16.7 years; p < 0.001); had longer duration of GC use (91.9 +/- 84.9 vs. 50.0 +/- 57.7 months; p < 0.001); and, for women, were more likely post-menopausal (81.5% vs. 18.5% premenopausal; p < 0.001). Fracture history was more common in those who received GIOP management (18 vs. 9 cases; p < 0.001). Calcium was the most commonly prescribed prevention strategy (84.5%). Recommendation of risk factor modification was seldom documented. Using multivariate logistic regression, rheumatologists were 4 times more likely to recommend GIOP prevention than the other two specialists. To improve the education in GIOP prevention strategies for specialists who commonly prescribe long-term GC, regular meetings and guidelines provided by experts in this field should be conducted. Both risk factors modification and pharmacological intervention for GIOP prevention should be started at the time of first GC prescription or as early as possible.
骨质疏松症是长期使用糖皮质激素（GC）的严重副作用，但预防效果甚微。我们旨在确定学术医生对糖皮质激素诱导的骨质疏松症（GIOP）风险的认识，以及决定 GIOP 管理的患者和提供者特征。对在阿拉巴马大学伯明翰分校由 4 名风湿病学家、3 名肺病学家和 3 名胃肠病学家诊治的 365 名患者进行了回顾性图表审查。其中，59.2%为女性，69.3%为白种人。仅有 110 名患者（30.1%）接受了任何类型的 GIOP 预防干预。接受 GIOP 预防的患者年龄更大（58.7 +/- 13.8 岁比 49.8 +/- 16.7 岁；p < 0.001）；GC 使用时间更长（91.9 +/- 84.9 个月比 50.0 +/- 57.7 个月；p < 0.001）；对于女性，更可能处于绝经后状态（81.5%比绝经前的 18.5%；p < 0.001）。接受 GIOP 管理的患者骨折史更为常见（18 例比 9 例；p < 0.001）。钙是最常开的预防策略（84.5%）。很少有记录建议进行危险因素修改。使用多变量逻辑回归，风湿病学家推荐 GIOP 预防的可能性是其他两位专家的 4 倍。为了提高常开长期 GC 的专家对 GIOP 预防策略的教育，应定期举办该领域专家提供的会议和指南。应在首次开具 GC 处方时或尽早开始进行 GIOP 预防的危险因素修改和药物干预。
